The Nasal Obstruction Symptom Evaluation Survey as a Screening Tool for Obstructive Sleep Apnea

Oral appliances (OA), a common treatment modality for obstructive sleep apnea (OSA), are not suitable for patients with nasal obstruction. Rhinomanometry, the gold standard technique to assess nasal airway resistance, is not readily available in sleep dentistry clinics. We demonstrate the use of a portable lightweight peak nasal inspiratory flow (PNIF) rate meter to objectively assess nasal airflow and utilized the Nasal Obstruction Symptom Evaluation (NOSE) scale to subjectively assess nasal obstruction in 97 patients with OSA and 105 healthy controls. We examined the correlations between the following variables between the groups: demographics, body mass index, PNIF, NOSE scale scores, apnea–hypopnea index (AHI), minimum SpO2 (SpO2min), Mallampati classification, and Epworth Sleepiness Scale (ESS) scores. Patients with OSA had significantly lower PNIF values and higher NOSE scores than controls. In the patient group, PNIF was not significantly correlated with AHI, SpO2min, Mallampati classification, or NOSE or ESS scores. Lower PNIF values and higher NOSE scores suggested impaired nasal airflow in the OSA group. As daytime PNIF measurement bears no relationship to AHI, this cannot be used alone in predicting the suitability of treatment for OSA with OA but can be used as an adjunct for making clinical decisions.

Download Full-text

Aerodynamics Analysis of the Impact of Nasal Surgery on Patients with Obstructive Sleep Apnea and Nasal Obstruction

ORL ◽

10.1159/000516243 ◽

2021 ◽

pp. 1-8

Author(s):

Lifeng Li ◽

Demin Han ◽

Hongrui Zang ◽

Nyall R. London

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Nasal Obstruction ◽

Upper Airway ◽

Apnea Hypopnea Index ◽

Nasal Surgery ◽

Subjective Sleep Quality ◽

Obstructive Sleep ◽

Significant Difference ◽

The Impact

Objective: The purpose of this study was to evaluate the effects of nasal surgery on airflow characteristics in patients with obstructive sleep apnea (OSA) by comparing the alterations of airflow characteristics within the nasal and palatopharyngeal cavities. Methods: Thirty patients with OSA and nasal obstruction who underwent nasal surgery were enrolled. A pre- and postoperative 3-dimensional model was constructed, and alterations of airflow characteristics were assessed using the method of computational fluid dynamics. The other subjective and objective clinical indices were also assessed. Results: By comparison with the preoperative value, all postoperative subjective symptoms statistically improved (p < 0.05), while the Apnea-Hypopnea Index (AHI) changed little (p = 0.492); the postoperative airflow velocity and pressure in both nasal and palatopharyngeal cavities, nasal and palatopharyngeal pressure differences, and total upper airway resistance statistically decreased (all p < 0.01). A significant difference was derived for correlation between the alteration of simulation metrics with subjective improvements (p < 0.05), except with the AHI (p > 0.05). Conclusion: Nasal surgery can decrease the total resistance of the upper airway and increase the nasal airflow volume and subjective sleep quality in patients with OSA and nasal obstruction. The altered airflow characteristics might contribute to the postoperative reduction of pharyngeal collapse in a subset of OSA patients.

Download Full-text

Implementing an educational program to increase preoperative screening for obstructive sleep apnea using the stop-bang questionnaire

International Journal of Advanced Nursing Studies ◽

10.14419/ijans.v5i1.5551 ◽

2016 ◽

Vol 5 (1) ◽

pp. 56 ◽

Cited By ~ 1

Author(s):

Adam Davies ◽

Monaghan W. Patrick ◽

Hogan Gerard

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Technology Acceptance ◽

Registered Nurse ◽

Screening Tool ◽

Perioperative Complications ◽

Nurse Anesthetists ◽

Perceived Usefulness ◽

Obstructive Sleep ◽

Registered Nurse Anesthetists

Background: Obstructive sleep apnea (OSA) is a potentially fatal disease process that has been linked to higher rates of morbidity and mortality as well as increased perioperative complications. OSA is characterized by repetitive pauses in breathing during sleep. Greater than 92% of women and 82% of men who are plagued by moderate to severe sleep apnea are undiagnosed and may go unrecognized in the perioperative setting. The gap between a high prevalence of undiagnosed OSA in the adult population and the low level of clinical recognition has been well-documented. The term “STOP-BANG” is an acronym for eight independent elements predictive of OSA—three are OSA-related symptoms, three are physiological measurements, and two are patient characteristics.Methods: This project used a quasi-experimental design using a 16-question self-developed survey based on the technology acceptance model (TAM). Participants were asked to read an educational pamphlet on OSA and then complete the survey.Results: This study found strong evidence to suggest that among Certified Registered Nurse Anesthetists (CRNAs) and Student Registered Nurse Anesthetists (SRNAs), those with higher scores on Perceived Ease of Use (PEOU), Perceived Usefulness (PU), and Attitude toward Use (AT), tend to have a higher Behavioral Intention to Use (BIU) the STOP-BANG screening tool.Conclusions: The results suggest that programs targeted at raising CRNAs’ and SRNAs’ PEOU, PU, and AT regarding the STOP-BANG questionnaire will culminate in increased use of the STOP-BANG screening tool. The use of this screening tool will detect patients previously unidentified as having OSA, and ultimately prevent perioperative complications associated with this disease.

Download Full-text

Validation of the Spanish Version of the STOP-Bang Questionnaire: Usefulness as a Screening Tool for Obstructive Sleep Apnea in Adults

Ear Nose & Throat Journal ◽

10.1177/0145561320932334 ◽

2020 ◽

pp. 014556132093233

Author(s):

Beatriz Delgado-Vargas ◽

Leticia Acle-Cervera ◽

Gianmarco Narciso López

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Screening Tool ◽

Sleep Apnea Syndrome ◽

Spanish Version ◽

Obstructive Sleep ◽

Significant Difference ◽

Good Internal Consistency ◽

The Mean ◽

Apnea Syndrome

Objectives: Obstructive sleep apnea syndrome (OSAS) is an increasing health problem, the diagnosis of which is generally delayed due to long waiting lists for the tests used to identify it. Therefore, tools that help on classifying patients at higher risk of suffering this syndrome have been developed. Methods: One hundred ninety-three consecutive patients, with and without OSAS, filled in the Spanish version of the STOP-Bang questionnaire in Hospital Universitario de Torrejón (Spain). Polysomnographies were performed to diagnose the presence and severity of the OSAS. Statistics analysis of the demographic characteristics of the sample and the questionnaire results was performed. Results: Most patients were male (73%) and the mean age was 50.4 years (ranging from 19-77 years). Cronbach α coefficient in the sample was 0.8072. A statistically significant difference was noted in the questionnaire scores between patients with OSAS and those without the syndrome. Conclusions: The Spanish version of the STOP-Bang questionnaire possess a good internal consistency that allows us to rely on it as a screening tool for patients with OSAS. In our sample, a difference in the questionnaire score was appreciated between patients with and without the syndrome, which strongly supports the utility of the questionnaire for its purpose.

Download Full-text

Cardiorespiratory Polygraphy for Detection of Obstructive Sleep Apnea in Patients With Atrial Fibrillation

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.758548 ◽

2021 ◽

Vol 8 ◽

Author(s):

Michiel Delesie ◽

Lieselotte Knaepen ◽

Johan Verbraecken ◽

Karolien Weytjens ◽

Paul Dendale ◽

...

Keyword(s):

Atrial Fibrillation ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Screening Tool ◽

Area Under The Curve ◽

Screening Tools ◽

Apnea Hypopnea Index ◽

Automated Algorithm ◽

Obstructive Sleep ◽

At Home

Background: Obstructive sleep apnea (OSA) is a modifiable risk factor of atrial fibrillation (AF) but is underdiagnosed in these patients due to absence of good OSA screening pathways. Polysomnography (PSG) is the gold standard for diagnosing OSA but too resource-intensive as a screening tool. We explored whether cardiorespiratory polygraphy (PG) devices using an automated algorithm for Apnea-Hypopnea Index (AHI) determination can meet the requirements of a good screening tool in AF patients.Methods: This prospective study validated the performance of three PGs [ApneaLink Air (ALA), SOMNOtouch RESP (STR) and SpiderSAS (SpS)] in consecutive AF patients who were referred for PSG evaluation. Patients wore one of the three PGs simultaneously with PSG, and a different PG during each of three consecutive nights at home. Severity of OSA was classified according to the AHI during PSG (<5 = no OSA, 5–14 = mild, 15–30 = moderate, >30 = severe).Results: Of the 100 included AF patients, PSG diagnosed at least moderate in 69% and severe OSA in 33%. Successful PG execution at home was obtained in 79.1, 80.2 and 86.8% of patients with the ALA, STR and SpS, respectively. For the detection of clinically relevant OSA (AHI ≥ 15), an area under the curve of 0.802, 0.772 and 0.803 was calculated for the ALA, STR and SpS, respectively.Conclusions: This study indicates that home-worn PGs with an automated AHI algorithm can be used as OSA screening tools in AF patients. Based on an appropriate AHI cut-off value for each PG, the device can guide referral for definite PSG diagnosis.

Download Full-text

The Use of Remotely Controlled Mandibular Positioner as a Predictive Screening Tool for Mandibular Advancement Device Therapy in Patients with Obstructive Sleep Apnea through Single-Night Progressive Titration of the Mandible: A Systematic Review

Journal of Clinical Sleep Medicine ◽

10.5664/jcsm.6202 ◽

2016 ◽

Vol 12 (10) ◽

pp. 1411-1421 ◽

Cited By ~ 14

Author(s):

Chloé Kastoer ◽

Marijke Dieltjens ◽

Eline Oorts ◽

Evert Hamans ◽

Marc J. Braem ◽

...

Keyword(s):

Systematic Review ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Screening Tool ◽

Mandibular Advancement Device ◽

Mandibular Advancement ◽

Device Therapy ◽

Obstructive Sleep ◽

Single Night

Download Full-text

0572 Using Anthropometric Measures to Screen for Obstructive Sleep Apnea in the Sleep Heart Health Study Cohort

SLEEP ◽

10.1093/sleep/zsaa056.569 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A219-A219

Author(s):

K D Vana ◽

G E Silva ◽

J D Carreon ◽

S F Quan

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Screening Tool ◽

Health Study ◽

Heart Health ◽

Height Ratio ◽

Cut Point ◽

Proxy Variables ◽

Obstructive Sleep ◽

Significant Difference

Abstract Introduction Individuals at high risk for obstructive sleep apnea (OSA) may not access sleep clinics for reasons including immobility, transportation difficulties, or living in rural areas. An easy-to-administer OSA screening tool for different body types, independent of witnessed apneas or body mass index (BMI), is lacking to identify this group quickly. We compared the sensitivities (SNs), specificities (SPs), and receiving operator curves (ROCs) of the neck circumference/height ratio (NHR) and waist circumference/height ratio (WHR) in predicting moderate and severe OSA (apnea-hypopnea index [AHI] ≥15/hr) with the SN, SP, and ROC of the derived Stop-Bang Questionnaire (dSBQ), which was created from proxy variables from the Sleep Heart Health Study (SHHS). Methods Data from the SHHS baseline evaluation were used and included participants (N=5431) who completed polysomnograms and had neck and waist circumferences, height measurements, and the SHHS proxy variables. This data then was divided randomly into 1/3 for derivation and 2/3 for validation analyses. Results No statistical differences were seen for gender, age, or ethnicity between the derivation and validation samples. In the validation sample (n=3621), the NHR cut-point of 0.21 resulted in a SN of 91% and a SP of 26% for AHI ≥15/hr. The WHR cut-point of 0.51 resulted in a SN of 91% and a SP of 21% for AHI ≥15/hr. Comparing the validation NHR and the dSBQ ROC curves showed no significant difference (AUCs=0.69 and 0.70, respectively; p=0.22). However, the ROC curve for WHR was significantly lower than for the dSBQ (AUCs=0.63 and 0.70, respectively; p<0.0001). Comparing the derivation and validation ROCs showed no significant differences between NHR ROCs, p=0.81, or between WHR ROCs, p=0.67. Conclusion The NHR is a viable screening tool, independent of witnessed apneas and BMI, that can be used for different body types and is statistically comparable to the dSBQ. Support This work was supported by U01HL53938 and U01HL53938-07S (University of Arizona).

Download Full-text

Nasal Obstruction Symptom Evaluation Score to Guide Mask Selection in CPAP-Treated Obstructive Sleep Apnea

Otolaryngology ◽

10.1177/0194599818773993 ◽

2018 ◽

Vol 159 (3) ◽

pp. 590-592 ◽

Cited By ~ 5

Author(s):

Marius Lebret ◽

Nathalie Arnol ◽

Jean-Benoît Martinot ◽

Renaud Tamisier ◽

Chrystèle Deschaux ◽

...

Keyword(s):

Sleep Apnea ◽

Nasal Obstruction ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Cpap Therapy ◽

Prospective Pilot Study ◽

Symptom Evaluation ◽

Obstructive Sleep ◽

Oronasal Mask ◽

Decision Making Tool

Nasal obstruction is frequently reported by patients with sleep apnea and complicates the choice of a nasal or oronasal mask for continuous positive airway pressure (CPAP) therapy. However, the type of interface used for the delivery of CPAP is crucial to ensure tolerance and compliance. The aim of this prospective pilot study was to identify whether the validated Nasal Obstruction Symptom Evaluation (NOSE) score rated at CPAP initiation was associated with the type of mask used after 4 months of treatment. Patients completed the NOSE questionnaire before initiation with automatic CPAP. The mask used (nasal/oronasal) after 4 months was documented. In total, 198 consecutive patients with sleep apnea were included. NOSE score (>50/100) was independently associated with the use of an oronasal mask at 4 months (sensitivity, 34.8%; specificity, 87.5%). The NOSE questionnaire could be a simple decision-making tool to guide the choice of mask during CPAP initiation.

Download Full-text

Inferior Partial Turbinectomy: An Effective Procedure for Chronic Rhinitis

Ear Nose & Throat Journal ◽

10.1177/014556139407300611 ◽

1994 ◽

Vol 73 (6) ◽

pp. 405-407 ◽

Cited By ~ 9

Author(s):

Steven Mucci ◽

Aristides Sismanis

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Local Anesthesia ◽

Nasal Obstruction ◽

Effective Procedure ◽

Safe Procedure ◽

Success Rates ◽

Chronic Rhinitis ◽

Obstructive Sleep

The safety and effectiveness of inferior partial turbinectomy (IPT) as a treatment for refractory chronic rhinitis was studied. Fifty-five patients, 34 males and 21 females, underwent IPT for chronic rhinitis, the majority under local anesthesia and in conjunction with septoplasty. Relief of nasal obstruction, rhinorrhea, snoring, headache, and obstructive sleep apnea was subjectively measured after an average follow-up of 18 months. We noted particularly high success rates - 92.3% and 85.5% - for nasal obstruction and rhinorrhea, respectively. Complications, in the form of post-op bleeding, were low at 3.7%. We conclude that IPT is an effective and safe procedure when properly performed. This work should help otolaryngologists become more comfortable in performing this old but controversial technique for treating chronic rhinitis.

Download Full-text